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<br />RABIES VACCINATION CERTIFICATE <br />ADAPTED NASPHV FORM 51 <br />Print - use ball point pen or type <br /> <br />Owner's Name & Address <br />PRINT LAST <br /> <br />( <br /> <br />NO. <br /> <br /> <br />SPEClpy SEX: <br />Dog ~ Male <br />Cat 0 . Female, <br />Other 0 ' Altered <br /> <br />(Specify) <br /> <br />SIZE: <br />Under 20 Ibs. <br /> <br />20 - 50 Ibs. <br /> <br />Over 50 Ibs. <br /> <br />DATE VACCINATED: <br /> <br />'8 ~Jf-Dh <br /> <br />Month Day Year <br /> <br />PRODUCER: <br /> <br />~ <br /> <br />VACCINATION EXPIRES: <br />g-~/-Dq <br /> <br />(First 3 Letters) <br />1 yr. Uc.Nacc. ~ <br /> <br />3 yr. LicNacc~ <br /> <br />/~soIA <br /> <br />Vacc. Serial (Lot) No. <br /> <br />Month Day Year <br /> <br />FDPC0129C <br /> <br />GY~b- <br /> <br />Tag fee $: <br />Tag#: d.- 3'7.5C:; <br /> <br />M.1. <br /> <br />Cert. Serial #: <br />TELEPHONE <br />tf J/j.; q 3 'J--3 <br /> <br />ZIP <br /> <br />STATE <br /> <br />PREDOMINANT BREED: <br />o n ~ L <br />o Gr~r .:jlu:~ <br />NAME: <br />iJ /j I <br />(;rr ~-Ia ~ <br /> <br />COLORS: <br /> <br />h/~elc <br />oJ..- -ftl4'J <br /> <br />Veterinarian's # <br />License No. <br /> <br />V''''ri",rii <br />Signature V ,,0 ~ <br /> <br />'St.''!: - X i;;AL ~S;;ITAl <br />SteHwcter, Minn. <br />43~1618 <br /> <br />~ ~o-:F\=- oCo 8 <br /> <br />VACCI~A1!ON 'RECORD <br />It f- 1.>-,") -h: "- <br />Name , -:r 1 ~o/ to\' <br />-B" RABIES <br />.....-EJ LYME DISEASE <br />~ CANINE DISTEMPER <br />.-EJ CANINE PARAINFLUENZ <br />~ CANINE ADENOVIRUS 2 <br />~ CANINE PARVOVIRUS' <br />, 0 CANINE CORONAVIRUS <br />o CANINE BORDETELLA <br />o LEPTOSPIROSIS <br />o CAN./FEL. GIARDIA <br />o FELINE LEUKEMIA <br />0' FEliNE PANLEUKOPEf\il, <br />o FELINE RHINOTRACHEIl <br />o FELINE CALlCIVIRUS <br />o FELINE CHLAMYDIA <br />o FELINE RINGWORM <br />o FELINE lMMUNODEFICIEN <br />VIRUS <br /> <br />~ <br /> <br />\fV\Gvl~ ~ ~ ~V~ \0 LJj;(Ct ' <br />1-\OZ Ll ~CA(~ S~ <br />L~vt\RA! 0~ \~ ~ <br /> <br />~\\~d \Dl~.lo~ <br /> <br />t:.~? ~~ rf'Or~rl;\;.[~~ j""!1 <br />,.,.- ,. ." ,'-, G\,d <br />'\..:.k=.=:.~~'~ll'" - <br /> <br />[,t"\7 0 p t-~tl~'~~~ <br />.:t/l j ~ Lu~tl <br /> <br />---.' "LLr- . ~ fld <br />CENiH-<.VI C,1\,'" <br />